BackgroundTo compare corneal hysteresis (CH) measurements between patients with glaucoma, ocular hypertension (OHT) and glaucoma-like optic discs (GLD)- defined as a cup to disc ratio greater than or equal to 0.6 with normal intraocular pressure (IOP) and visual fields. The secondary aim was to investigate whether corneal resistance factor (CRF) and central corneal thickness (CCT) differ between patient groups.MethodsIn this cross sectional study a total of 123 patients (one eye each) were recruited from a glaucoma outpatient department to undergo ocular response analyser (ORA) testing and ultrasound pachymetry as well as clinical examination. A One-way Analysis of Covariance (ANCOVA) was conducted to evaluate the mean difference in CH between the three diagnostic groups (glaucoma, OHT and GLD) correcting for potential confounding factors, IOP and age. Analysis was repeated for CRF and CCT.ResultsThere was a significant difference in mean CH across the three diagnosis groups; F(2, 115) = 96.95; p < 0.001. Mean CH significantly higher for GLD compared to glaucoma (mean difference 1.83, p < 0.001), and significantly higher for OHT compared to glaucoma (mean difference 2.35, p < 0.001). Mean CH was slightly lower in patients with GLD than those with OHT but this difference was not statistically significant. A similar pattern was seen when the analysis was repeated for CRF and CCT.ConclusionsHigher CH in GLD and OHT compared to glaucoma suggests increased viscoelasticity of ocular tissues may have a protective role against glaucoma.

Statins inhibit the enzyme 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, and hence have a profound effect in lowering serum cholesterol. Their predominant clinical use to date is in primary and secondary prevention of cardiovascular disease. However recently interest has developed regarding the so-called "pleiotropic" effects of statins-these drugs have significant anti-fibrotic, anti-inflammatory, and immunomodulatory properties. Such effects of statins have already been shown to be beneficial in modulating the pathological mechanisms involved in pulmonary fibrosis, renal disease, non-ischaemic cardiac failure, and tissue scarring. Many of these actions are mediated by inhibition of the Rho kinase pathway. Epidemiological studies suggest that patients who take statins have a lower risk of developing glaucoma, and lower rates of glaucoma progression. Here, we review what is known about the pleiotropic effect of statins to date, and examine how these effects may modulate the molecular mechanisms involved in glaucoma pathogenesis.

Pseudoexfoliation syndrome (PXS) and pigment dispersion syndrome (PDS) are two of the commonest disorders to produce secondary open-angle glaucoma through trabecular meshwork blockage. Each is a defined clinical entity, and while genetics likely play a significant role in the pathogenesis of both, the specific genes involved appear to be distinct. There is surprisingly little published in the literature regarding the coexistence of PDS and PXS in the same patient. We present the intriguing case of a patient who developed PDS in one eye and PXS in the other. This unusual case acts as a platform for an interesting discussion of the genomics of PXS and PDS.

Aim: This study investigates whether the post intravitreal injection intraocular pressure (IOP) spike is modifiable with the use of prophylactic apraclonidine and dorzolomide. Methods: The study design was a prospective, randomised controlled trial. 80 eyes undergoing intravitreal injection of anti-VEGF agent were studied. A control group (n = 42) received no IOP lowering drops, and a study group (n = 38) received guttae apraclonidine and dorzolamide 30 to 40 minutes before the intravitreal injection. IOP measurements were taken in both groups using the Perkins tonometer at baseline, immediately before and after the injection, 5 minutes post-injection, and 15 minutes post-injection. Results: Mean IOP immediately post injection in the study group was 26.71 mmHg, and in the control group was 32.73. The main outcome measure was the area under the curve (AUC)-reflecting the trend of IOP post injection. The AUC was lower in the study group compared to the control group (Mann-Whitney U test, p = 0.046). Conclusions: The use of prophylactic apraclonidine and dorzolamide is effective in modifying the post-injection IOP spike. IOP lowering prophylaxis may be considered in patients with a high baseline IOP.